Imposing regulations without evidence

“Experts” consistently champion evidence based medicine. Policy wonks opine that we could greatly improve patient care if we more consistently followed the evidence. Evidence has become a major buzzword in health care.

Yet too often regulations impact physicians that have no evidence base. I have argued against the clinical skills exam for many years. Please read this Washington Post article about the exam, “$1,300 to take 1 test? Med students are fed up.“

How about the method of note writing that Centers for Medicare and Medicaid Services inspired? Does anyone believe that our notes have improved with the billing requirements?

Do these impositions follow evidence? No! A regulation body imposes something that has face validity to them, but not to us.

As children we often learn the famous saying “What is good for the goose is good for the gander.” If evidence is really important (and why else do we even consider performance measurement), then we should hold the same standard to these regulations. We should not have regulations that impact health care imposed without a strong evidence base.

But then the world does not always act rationally.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.
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